Authors (including presenting author) :
Lau ACH, Wong EYW, So JKW, Pow LWS, Cheung EYY, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital
Introduction :
Spinal cord injury(SCI) constituted low volume but high complexity unique clientele requiring specific and often lengthy rehabilitation journey. Spinal Cord Independence Measure Version III(SCIM III) with reported high validity and reliability[1] was designed for assessing SCI patients’ functional performance in daily routine[2]. Establishing the predictive validity of SCIM III would enhance the utility as triage tool for matching SCI patients of different potentials with their required rehabilitation pathway facilitating discharge planning and opportune resource utilization.
Objectives :
The current study was conducted for evaluating the predictive validity of SCIM III in SCI patients’ discharge functional mobility status and its cutoff score.
Methodology :
Case records of SCI patients admitted to Kowloon Hospital during 2005-2022 were analyzed. The SCIM data was collected by direct observation of patients upon admission and discharge by case physiotherapists. Discharge functional mobility status and length of stay(LOS) were collected. Receiver Operating Characteristics(ROC) curve was used to analyze the predictive validity of SCIM III in differentiating patients as non-walker, indoor or outdoor walker upon discharge.
Result & Outcome :
Records from 286 patients(Male=64%(183), Female=36%(103)) aged 62.2±16.0 with LOS≤200 days were included in the study. Upon discharge, for the criteria as indoor walker, the Area Under Curve(AUC) was 0.829 (95%CI: 0.777-0.882,p<0.001) and for the criteria as outdoor walker, AUC was 0.760(95%CI: 0.703-0.826,p<0.001). The optimal cutoff score of SCIM III of admission was 31 for indoor walker (sensitivity=0.681;specificity=0.904) and 40 for outdoor walker(sensitivity=0.667;specificity=0.728). Further analysis through linear regression model with age-controlled revealed that LOS was positively correlated with improvement of SCIM score(β=0.125,p=0.001) for patients above cutoff of SCIM III for indoor walker upon admission. No correlation was found in patients below the cutoff(β=-0.082,p=0.592).
Thus, admission SCIM score demonstrated effective prediction for patients’ functional mobility status upon discharge. The positive correlation between LOS and improvement in SCIM score for potential SCI walkers, might justify the rehabilitation need for intensive rehabilitation pathway. Early prognostic prediction of patients’ ambulatory potential at admission facilitates stratified rehabilitation and clinicians’ discharge planning at initial stage of rehabilitation. The established predictive validity of SCIM III supported the utility as triage tool for justified care in matching SCI patients of different potentials with their required rehabilitation pathway facilitating discharge planning and opportune resource utilization. References: [1] Catz A, Itzkovich M, Tesio L, Biering-Sorensen F, Weeks C, Laramee MT, et al. A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation. Spinal Cord. 2007;45(4):275-91. [2] Catz A, Itzkovich M. Spinal Cord Independence Measure: comprehensive ability rating scale for the spinal cord lesion patient. J Rehabil Res Dev. 2007;44(1):65-8.
